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Increasing numbers of young children with significant social and emotional difficulties are being identified in childcare settings. Early Childhood Mental Health (ECMH) Consultation has been identified as a promising practice in stemming the tide of this troublesome trajectory. While ECMH Consultation is credited with promoting children's positive development, diminishing difficult behaviors, and reducing expulsion rates, the mechanisms of this transformative process are only beginning to be investigated. Recent research cites the salience of the relationship between a consultant and consultee as the central contributor to positive change in childcare-center climate and child outcomes. This article delineates characteristics of a beneficial consultative relationship and postulates the clinical process by which change in childcare providers' behavior occurs as a result of having experienced such a relationship. Paralleling the traits of contingent caregiving, the consultative stance, a posture of mutuality, reciprocity, and positive regard creates an intersubjective space for reflection, repair, and, when necessary, adaptation. Based on perceptual shifts or expansions, the providers' attitude and approach toward children in their care is amended, in turn promoting positive change in the child and classroom atmosphere.

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The number of infants and young children affected by homelessness and domestic violence is growing, and the effect of these experiences on children is wide-ranging. Early childhood mental health consultation (ECMHC) has expanded to these settings to help the adults attend to very young children whose needs are often obscured by families' crises. Recent research in ECMHC to childcare has cited the salience of the consultant-consultee relationship as the central contributor to positive change in caregiver's behavior and children's experience. This article explores the similarities and variations in the consultant's way of being that are necessary to expand this relationship-based ECMHC model to adult-focused settings. This has incorporated a combination of consultative shifts: expanded training, appreciation for families' survival priorities, attention to the effects of unavoidable adult decisions on children, increased tolerance for the affect this raises in parents and caseworkers, and greater efforts to create space for reflection and thinking. Caseworkers' attenuated contact with and limited prior knowledge about young children creates challenges in identifying and responding to concerns about children. The particular systemic and relational difficulties that emerge in shelters and that influence caseworkers' responsiveness to clients are explored.